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James' Surgery And Resurgence

November 14, 2011 - Filed under: teamTBB

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“Man, I love riding my bike!” We had just crested another climb on the final day of a week full of climbing. We were riding back to Leysin, Switzerland from Albertville in France, through Chamonix-Mont Blanc. It must be some of the best riding in the world and I was enjoying it as only someone who has experienced cycling and has a serious addiction to exercise can understand. The weather was amazing, the scenery stunning and the exhaustion-induced grumpiness of my riding partners only served to bolster my good mood – it takes a lot time and energy to get that tired and always seems a waste to me to not revel in the feelings… There was only one thing bothering me. My knee was sore. I’ve had sore knees before, and all sorts of other overuse injuries - no doubt somewhat linked to the same enjoyment of fatigue – but this was different. (Hindsight is always full of obvious observations, but I really should have taken more note of this uniqueness.) Regardless, I had to get home and riding was the only way. And the discomfort was bearable and not getting worse (another clue!).

Once back in Leysin a more thorough assessment was done, but seeing as it bothered me running and biking and rest wasn’t helping, it wasn’t long before I sought some expert advice. I was referred to Patrik Noack at the Swiss Olympic Medical center, and he diagnosed Medial Plica Syndrome and gave me a cortisone shot, saying if that didn’t work then an arthroscope to remove the offending cartilage was the next step. The diagnosis, once I had learned about it as I had never heard of it before then, fit perfectly with every symptom I had and intuitively I knew it was the correct diagnosis. And, of course, Patrik was completely correct, and as I sit here now I have been mostly confined to the couch for the past week as I had my Plica removed in a quick operation last Friday. But 12 weeks passed between the cortisone and that ‘next step’… Before I could get the op done in Switzerland my 90-day visa was to expire, and besides, I had medical cover in South Africa.

It was a simple procedure and could be done anywhere I was told. So I flew home to South Africa and got the advice to see a Dr. Willem van der Merwe at the Sport Science Institute - apparently one of the best knee guys in the world. A week-long wait to see him and then I was hopeful my injury would be well on its way to being history. As I met him and started telling him the history of the injury I got the distinct impression he was only half-listening. And when I told him it was diagnosed as Plica Syndrome he all but laughed at me and told me it definitely was not Plica (having not yet even looked at my knee!). He said it’s probably tendonopathy and we’ll get an MRI there and then to confirm. The MRI confirmed nothing, but he said, “I can see your Plica, but it definitely not the problem here.” I was prescribed a program on the Grucox eccentric cycle ergometer to ‘balance my muscles and get my knee tracking correctly’. Two weeks of this and my frustration was mounting – there was no discernible improvement and the standard line was “These things take time”. The Grucox machines certainly work and I imagine they would help enormously if a muscle imbalance was your issue. But muscle-imbalance was not my issue.

Another expert was sought, through a friends’ reference and this time I went to a ‘guru’ in muscle activation. He worked his magic and I have to say that it certainly made a difference to my well-being and made my body, feeling out-of-sync after 6 weeks of not training, feel happier. But this will only help you if your issue was an alignment or balance issue. But muscle activation was not my issue. I sought another Orthopedic knee guy as the manner of the first guy was still irking me – I felt he had been arrogant and not given my situation the time it deserved. I went to Spike Erasmus in Stellenbosch. He was far more concerned and determined to get to the bottom of it. But he was also adamant that he would not do anything dramatic like operate until I had tried complete rest for 4-6 weeks, thereby ruling out any inflammatory conditions.

So Jodie and I went on holiday and I resigned myself more waiting. After the holiday I saw a great bio/physio in Stellenbosch, Francois Retief who applied his expertise to my problem. But he too was at a bit of a loss in my case. Eventually my zen-like calm ran out and my frustration got the better of me and I went for a run to see if the then 4 week of rest had helped… I got to two minutes. Intense frustration! I immediately went for a new MRI, and booked in to see the Ortho again. The MRI confirmed immediately that I had an enlarged Plica. As it turns out, the MRI I got previously at the SSISA and on the direction of ‘the best knee guy in SA’ was a low resolution MRI and completely missed the Plica. How the ‘best knee guy’ uses MRI’s that don’t show the problem to rule out said problem is beyond me… The new MRI was conclusive, but there was still a small chance that either the Plica was not pathological, or that it could be solved with cortisone. We tried the cortisone, but it was obvious that it was making no difference and so, 12 weeks after it was actually diagnosed instead of 1 week, I had the op.

Apparently once in the knee with the camera it was very clear that the Plica was pathological and it was actually bleeding, something which is very unusual. It was removed a week ago today, and my progress has been rapid. I am still limping a bit and no running or biking yet, but I am sure that after a few more days for the stitches and bruising to heal I will be back on the road to full fitness and racing again. I learned many lessons from this injury (mostly that ‘the best’ doctors don’t know your body half as well as you know you!) and I am sure that I will come back from this injury well-rested, wiser and a whole lot more motivated! Look out 2012… Onwards and upwards…